C P Ho1, A V Krassioukov. 1. International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
STUDY DESIGN: A case report of silent myocardial ischemia in a man with C5 AIS A (American Spinal Injury Association Impairment Scale) tetraplegia during an episode of autonomic dysreflexia (AD). OBJECTIVE: The aim of this study was to show a clinical presentation of myocardial ischemia in individuals with spinal cord injury (SCI). CASE REPORT: A 45-year-old man with chronic C5 complete SCI presented with an episode of uncontrolled AD. He denied any symptoms of typical myocardial ischemia. Despite initiation of the AD management protocol, his blood pressure remained elevated. Additional testing revealed an unexpected horizontal ST depression in the lateral leads with a significant elevation of troponins. A follow-up cardiac angiography and MIBI cardiac perfusion scan revealed normal left ventricular contractility and no evidence of coronary artery occlusion. CONCLUSIONS: In individuals with SCI, the loss of sensory input from the myocardium to supraspinal structures predisposes them to asymptomatic myocardial ischemia. Furthermore, during an episode of AD, a significant increase in visceral sympathetic activity with coronary artery constriction can result in myocardial ischemia, even in the absence of coronary artery disease.
STUDY DESIGN: A case report of silent myocardial ischemia in a man with C5 AIS A (American Spinal Injury Association Impairment Scale) tetraplegia during an episode of autonomic dysreflexia (AD). OBJECTIVE: The aim of this study was to show a clinical presentation of myocardial ischemia in individuals with spinal cord injury (SCI). CASE REPORT: A 45-year-old man with chronic C5 complete SCI presented with an episode of uncontrolled AD. He denied any symptoms of typical myocardial ischemia. Despite initiation of the AD management protocol, his blood pressure remained elevated. Additional testing revealed an unexpected horizontal ST depression in the lateral leads with a significant elevation of troponins. A follow-up cardiac angiography and MIBI cardiac perfusion scan revealed normal left ventricular contractility and no evidence of coronary artery occlusion. CONCLUSIONS: In individuals with SCI, the loss of sensory input from the myocardium to supraspinal structures predisposes them to asymptomatic myocardial ischemia. Furthermore, during an episode of AD, a significant increase in visceral sympathetic activity with coronary artery constriction can result in myocardial ischemia, even in the absence of coronary artery disease.
Authors: Andrei Krassioukov; Jennifer R Tomasone; Melissa Pak; B Catharine Craven; Mohammad H Ghotbi; Karen Ethans; Kathleen A Martin Ginis; Michael Ford; Dmitri Krassioukov-Enns Journal: J Spinal Cord Med Date: 2015-06-25 Impact factor: 1.985
Authors: Jennifer R Tomasone; Kathleen A Martin Ginis; Wayland Pulkkinen; Andrei Krassioukov Journal: J Spinal Cord Med Date: 2014-07-24 Impact factor: 1.985
Authors: K A Martin Ginis; J R Tomasone; M Welsford; K Ethans; A R Sinden; M Longeway; A Krassioukov Journal: Spinal Cord Date: 2016-09-13 Impact factor: 2.772